Purpose: To evaluate whether antepartum anemia is associated with adverse maternal and perinatal outcomes in women with placenta accreta spectrum (PAS). Patients and Methods: This multicenter retrospective study included 984 women with PAS from three Chinese tertiary hospitals between September 2016 and July 2025. Eligible participants had singleton pregnancies and delivered at ≥ 28 weeks. PAS was confirmed by failure of spontaneous placental separation during delivery or by pathology. Anemia was defined as hemoglobin < 110 g/L. To minimize baseline imbalance, propensity score matching was performed using a 1:1 nearest neighbor matching algorithm with a caliper width of 0.2. Group comparisons used the Chi-square, Fisher’s exact, or Mann–Whitney U test. Univariable and multivariable logistic regression identified independent risk factors for adverse outcomes. Results: Among 984 participants, the incidence of anemia was 32.1%. Anemia group had higher rates of severe PAS subtypes, placenta previa, and vaginal bleeding. The matched analysis included 277 women per group, and the main residual difference was transfusion requirement (median 4 vs 2 units, P < 0.001) and composite adverse maternal outcome ( P = 0.006). Multivariable analysis identified anemia as an independent risk factor for adverse maternal outcomes (OR 1.84, 95% CI 1.22– 2.78, P = 0.004). Other independent risk factors included placenta increta/percreta (OR 25.56) and ultrasound signs. Anemia was not associated with adverse perinatal outcomes. Protective factors for perinatal outcomes included longer gestation (OR 0.65) and cesarean delivery (OR 0.01), whereas emergency delivery increased risk (OR 3.75). Conclusion: In women with PAS, antepartum anemia is associated with increased adverse maternal risk, especially transfusion requirements. This supports attention to anemia screening and optimization in PAS care pathways, which may reduce blood resource burden in resource-limited regions. When antepartum anemia cannot be adequately corrected before delivery, sufficient blood preparation is essential. Keywords: placenta accreta spectrum disease, anemia, maternal-perinatal outcomes, propensity score matching
Feng et al. (Fri,) studied this question.